A patient with peripheral artery disease seeks care for a decade before finding a solution at UF Health.
Peripheral artery disease, or PAD — also called peripheral vascular disease or PVD — is a condition that affects blood circulation in places outside of the heart and brain, such as in the arms, legs or kidneys. PAD is caused by the narrowing of blood vessels and arteries due to a buildup of plaque (fatty deposits) known as atherosclerosis. This silent, progressive process limits the blood flow that is vital for tissue and organ survival.
Our team of cardiovascular specialists are leaders in effectively diagnosing, treating and managing PAD. Patients who are diagnosed early and receive aggressive medical treatment may be able to avoid serious health problems.
Peripheral artery disease: Areas affected
Some of the most commonly affected arteries of the body are those in the legs, from your buttocks to your feet. Symptoms usually occur at the end stage of this disease, when the blockage causes limited blood flow to the legs. However, almost 80% of people with PAD do not have any symptoms at all but are at a high risk for heart attack, stroke and death. Due to this silent process, early diagnosis is very important in preventing serious complications associated with PAD.
PAD can present as a chronic condition that causes claudication (pain in the calves, thighs or buttocks when walking which resolves at rest) or as an acute condition (critical limb ischemia) that occurs due to an embolus or a blood clot that obstructs the blood flow to the limb. This is an emergent condition that requires urgent intervention for limb salvage.
Peripheral artery disease: Who is at risk?
There are several risk factors including family history, age, diabetes, tobacco use and diagnosed coronary artery disease. If a patient has already had a heart attack or a stroke, they should be evaluated for PAD. Other factors include being obese, having an inactive lifestyle, high blood pressure and high cholesterol. If a patient has one of more of these factors, their health should be actively monitored by a primary care physician and, if needed, a cardiovascular specialist. If patients are over 70 years of age, they should be screened for PAD, especially if they have two or more risk factors.
Peripheral artery disease: Symptoms
The symptoms of PAD depend on which area of the body is affected. When a blood vessel of the leg or arm is affected, patients will feel cramping, heaviness, pain or discomfort in the legs, particularly in the calves, buttocks or arms with activity. They may also experience:
- Burning or aching pain in the feet and toes while resting, especially at night while lying flat
- Changes in skin temperature in the legs, feet or toes
- Erectile dysfunction
- Increased occurrence of infection
- Loss of hair in the chin area
- Numbness or tingling in the legs, feet or toes
- Redness or other color changes in the skin
- Toe and foot sores that do not heal
When PAD affects blood vessels of the kidneys, symptoms include sudden high blood pressure (hypertension) or blood pressure that is difficult or impossible to control with medication. When left untreated, PAD affecting the kidneys can result in kidney failure.
Peripheral artery disease: Diagnosis
Our specialists have access to the latest research in diagnosing PAD and use some of the region’s most advanced technology to establish the extent of the condition. A thorough medical history and physical exam, along with an assessment of risk factors, is performed and several diagnostic tests are available to confirm the presence of PAD and determine the appropriate course of treatment. Most of these tests are noninvasive and painless, including:
- Angiography is a minimally invasive procedure that inserts a small catheter in the artery and injects dye to define the degree of blockage in your arteries. This is the “gold standard” procedure.
- Ankle brachial index (ABI) compares blood pressure in the ankle and in the arm using a regular blood pressure cuff and a Doppler ultrasound device.
- Multi-level ABI (also called segmental ABI) places cuffs on each calf, above the knees and at the thighs, in addition to the arms and ankles. This reading will help pinpoint where in the arteries the blockages occur.
- Single-level ABI places cuffs on the upper arms and at the ankles while a Doppler (probe) is placed on the pulse at the feet to hear the sound of the artery.
- Stress ABI is used when patients have intermittent claudication (too little blood flow) that can cause severe muscle cramping in the legs, calves, buttocks or arms as the result of exercise. After the multi-level ABI is performed, the patient is placed on a treadmill for five minutes, or until they are unable to continue walking. Pressures are recorded as soon as possible.
- Computed tomography angiogram (CTA) is a noninvasive procedure to define the degree of blockage with an injected dye.
- Magnetic resonance angiogram (MRA) is used to obtain images of blood vessels and their function inside the body.
- Pulse volume recordings (PVR) is a noninvasive vascular test in which blood pressure cuffs and Doppler are used to get information about arterial blood flow in the arms and the legs. This information is then used to determine the presence, severity and general location of peripheral vascular disease.
- Ultrasound imaging is a noninvasive study of the affected vessels using Doppler — high-velocity sound waves — to assess the degree of blockage.
Peripheral artery disease: Treatments
By taking a whole-person approach to individualized treatment plans, our cardiovascular specialists are able to determine optimal therapies for each patient. Recommendations may include lifestyle changes, medications or in severe cases, more aggressive treatment.
Adopting a healthier lifestyle can make a significant difference for people with PAD. Our specialists are here to help patients with the right information and encouragement to make changes:
- Begin a regular exercise program, such as walking. Patients who walk regularly can expect a marked improvement in the distance they are able to walk before experiencing leg pain. Exercising at our closely monitored cardiac rehabilitation program may be a good option.
- Control diabetes by taking prescribed medications and seeing a doctor regularly.
- Control blood pressure with diet, exercise and, when needed, medicatio.n
- Eat a high-fiber, low-fat, low-cholesterol, low-sodium diet. Limit fat to 30% of the total daily calories. Avoid trans fats, including products made with partially hydrogenated and hydrogenated vegetable oils.
- Maintain a healthy weight.
- Manage stress in a healthy way.
- Quit smoking. Ask the doctor about smoking cessation programs available in the community.
A number of established and advanced medications are used to treat PAD. These may include:
- Blood pressure medication to control blood pressure.
- Blood thinning medication to help reduce the risk of blood clots.
- Statin medication to reduce cholesterol levels.
When other therapies are not enough and in stages of advanced PAD, interventional procedures may be needed to provide relief. These can include:
- Angioplasty is a nonsurgical procedure in which a specialist accesses narrowed arteries by using a catheter and a balloon to access the affected artery and open the blockage.
- Atherectomy or thrombectomy remove blockages or obstructions like plaque, calcium or clots. There are different types of atherectomy devices according to the type of the lesion — laser, orbital or directional. In case of blood clot, thrombectomy devices or infuse medication are used to break the clots.
- Bypass grafting is a procedure in which a surgeon uses an artery from the chest or wrist or a vein from the leg to bypass arteries that have been narrowed due to peripheral vascular disease.
- Stenting is when a mesh device is taken to the affected artery with a catheter to support the cleared vessel and keep it open. There are stents that are balloon expandable or self-expandable and some are coated with medications to prevent scar tissue from building up inside the stent.
Why choose UF Health Jacksonville?
As part of a leading academic health center, the specialists who staff our PAD Program are professors and researchers in one of the nation’s largest cardiovascular training programs. We have experts in endovascular interventions using state-of-the-art techniques and technology to treat the most difficult cases, perform a large number of below-the-knee and limb-salvage procedures. UF Health Jacksonville participates in innovative research and has access to the latest equipment to treat PAD with more options than other facilities, which we believe offers the best possible outcomes for our cardiovascular patients.
Frequently asked questions
Is there a cure for PAD?
There is no cure for PAD, but by quitting smoking, exercising regularly, limiting fat and following a healthy diet while managing your risk factors, you can help to reduce the progression of the disease.
Who is at risk of developing PAD?
You are at an increased risk for developing PAD if you:
- Are African-American
- Have diabetes
- Have been diagnosed with heart disease
- Have a family history of PAD
- Have high blood pressure
- Have high cholesterol
- Have a history of stroke
- Lead an inactive lifestyle
- Are obese
- Are over 50 years old
What other problems can occur from PAD?
If left untreated, patients with PAD can develop serious health problems, including:
- Heart attack
- Renal artery disease or stenosis
- Transient ischemic attack (TIA)
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